Abstract
Background Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are unknown. The aim of this study was to describe the quality and architecture of urothelium and bladder submucosa in patients undergoing TUR complicated by bladder perforation. Methods Fifteen patients who underwent TUR complicated by a bladder perforation were retrospectively enrolled into this morphological analysis (group 1). As a control group, 15 patients, who had undergone uncomplicated TUR, were matched (group 2). Surgical specimens were collected from all participating patients. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed in transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in bladder submucosa and the presence of degenerative changes in the urothelium. Results Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. Immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From clinical point of view, ultrastructural analysis by electron microscopy showed higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32). Conclusions Bladder perforation during transurethral resection of bladder tumour is not a result of deficient structure of the bladder wall and surgical technique seems to play the most important role in its prevention.
Intravesical Instillation of Mitomycin C: A Cause of Delayed Bladder Perforation?